<div class="inn-tip">您需填写真实信息，否则将影响申请分期。</div>

<!-- 房东姓名 -->
<div class="weui-cell">
  <div class="weui-cell__hd">
    <label class="weui-label">房东姓名</label>
  </div>
  <div class="weui-cell__bd">
    <input class="weui-input" type="text" placeholder="请输入您的姓名">
  </div>
</div>

<!-- 联系电话 -->
<div class="weui-cell">
  <div class="weui-cell__hd">
    <label class="weui-label">联系电话</label>
  </div>
  <div class="weui-cell__bd">
    <input class="weui-input" type="tel" placeholder="请输入11 位手机号码">
  </div>
</div>

<!-- 申请分期房客姓名 -->
<div class="weui-cell">
  <div class="weui-cell__hd">
    <label class="weui-label">申请分期房客姓名</label>
  </div>
  <div class="weui-cell__bd">
    <input class="weui-input" type="text" placeholder="请输入">
  </div>
</div>

<!-- 申请分期房客电话 -->
<div class="weui-cell">
  <div class="weui-cell__hd">
    <label class="weui-label">申请分期房客电话</label>
  </div>
  <div class="weui-cell__bd">
    <input class="weui-input" type="tel" placeholder="请输入">
  </div>
</div>

<!-- 申请按钮 -->
<div class="weui-btn-area">
  <a class="weui-btn" href="javascript:;" id="js-submit">我要分期</a>
</div>